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2016 Insurance Code Revisions - Compliance and Filing FAQ

2016 Insurance Code Revisions - Compliance and Filing FAQ

Updated 03/12/2020

PA 276, an Act amending the Michigan Insurance Code, had immediate effect, July 1, 2016. Enacting section 3, states: “On the effective date of this amendatory act, an insurer may submit to the director of the department of insurance and financial services for approval any modification to policies and certificates that were approved before or on the effective date of this amendatory act, to conform with amendments made to the insurance code.” (Emphasis added)

PA 274 (Patients Right to Independent Review Act) and PA 275 (Coordination of Benefits) were also enacted.

Due to the effective date being mid-year, DIFS is providing the following information to assist Issuers.

All filings submitted for compliance purposes should include both red-lined and clean versions.

Frequently Asked Questions

  • When will Issuers have to comply with PA 274, PRIRA?

    PRIRA changes were due on 9/15/16. If the internal formal grievance procedure under MCL 500.2213 requires modifications to correspond with the changes for PRIRA, both must be filed at the same time. DIFS requires all Issuers submit the required PRIRA changes no later than 9/15/16. The filing should include BOTH a red-lined and clean version.

    If an Issuer has missed this deadline, PRIRA changes should be submitted immediately.

  • When will individual and small group ACA-compliant (those filing plans for on/off the Marketplace) be required to submit PA 276 and PA 275 compliant forms?

    Individual and small group Issuers submitting filings for on/off the Marketplace for plan year 2018 must include forms that comply fully with all PA 276 and PA 275 changes.

  • When will large group Issuers be required to submit PA 276 and PA 275 compliant forms?

    Large group Issuers must submit all of their certificates, policies, riders, and forms to fully comply with all PA 276 and PA 275 changes the earliest of 1/1/17 or the Issuer’s annual filing date for 2017. While DIFS does not review large group rates (other than HMO large group rates), Issuers do have some point annually when adjustments are made to their rate tables and/or trends. It is that annual date to which DIFS would refer to as an annual filing date.

  • If an Issuer is submitting any other filing type (not ACA-related filings or large group), when will it be required to demonstrate compliance with PA 276 and PA 275?

    For example, filings for other lines of coverage such as specified disease, indemnity, vision, dental, disability income, or accident.

    All other issuers will need to submit fully compliant forms as follows:

    If a certificate or policy was approved in 2016 before 7/31/16, that approval will stand for one year. The Issuer will then need to submit a new filing to demonstrate compliance with PA 276 and PA 275. Filings should be submitted at least 60 days prior to the requested effective date.

    If a certificate or policy was approved in any year prior to 2016 and has not been updated since then, a new filing to fully comply with PA 276 and PA 275 must be submitted no later than the end of 2016.

    Beginning 1/1/17, an Issuer must submit all of its certificates, policies, riders, and forms not previously filed under PA 276 and PA 275 to fully comply with PA 276 and PA 275.  These should be submitted the earliest of 1/1/17 or the Issuer’s annual filing date for 2017, as noted above. The annual filing date is the date the Issuer adjusts their rate tables and/or trends.

    Any policy or certificate submitted after 7/31/16 must comply with PA 276 and 275.

The answers provided are not meant to be a substitute for legal advice.